Provider Demographics
NPI:1649389552
Name:PEDIATRIC ASSOCIATES INC. OF BROCKTON
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES INC. OF BROCKTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:ASIAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-584-1234
Mailing Address - Street 1:370 OAK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1303
Mailing Address - Country:US
Mailing Address - Phone:508-584-1234
Mailing Address - Fax:508-584-0230
Practice Address - Street 1:370 OAK ST
Practice Address - Street 2:SUITE A
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1303
Practice Address - Country:US
Practice Address - Phone:508-584-1234
Practice Address - Fax:508-584-0230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty